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[Trends in pharmacological treatment of congestive heart failure]
1Katedry i Kliniki Kardiologii AM we Wrocławiu.
Insights
Congestive heart failure (CHF) treatments aim to slow disease progression and improve survival. ACE inhibitors and beta-blockers show promise in reducing mortality and worsening CHF, while other drugs have varied effects.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Congestive heart failure (CHF) is a growing public health concern with increasing incidence, prevalence, and mortality.
- Hypertension and atherosclerotic vascular diseases are major risk factors for CHF, highlighting the importance of aggressive management.
Purpose:
- To review current treatment strategies for congestive heart failure (CHF).
- To evaluate the efficacy of various medications in improving clinical endpoints and survival in CHF patients.
Summary:
- Diuretics manage fluid retention but do not alter CHF prognosis.
- Angiotensin-converting enzyme (ACE) inhibitors decrease mortality and slow CHF progression, recommended for left ventricular dysfunction.
- Beta-blockers, particularly carvedilol, improve hemodynamics, ejection fraction, and survival when combined with other therapies in stable CHF patients.
Impact:
- Aggressive treatment of hypertension and hyperlipidemia can prevent CHF.
- Certain medications like ACE inhibitors and beta-blockers offer significant survival benefits and improved quality of life for CHF patients.
- Careful selection of pharmacotherapy is crucial for managing CHF effectively, with some agents demonstrating risks of increased mortality.
Abstract:
Congestive heart failure (CHF) is growing epidemiologic and clinical problem, and is the only common cardiovascular condition that is increasing in incidence, prevalence and mortality. During last years numerous clinical trial have been conduced evaluating the effect of various treatment procedures on clinical endpoints in patients with CHF. The major risk factor for CHF are hipertension and atherosclerotic vascular diseases, and now it is clear that aggressive treatment of hypertension and hyperlipidemia can be effective in preventing CHF. Treatment strategies for CHF are aimed at preventing and delaying progression of the disease and improving survival. In the treatment of CHF diuretics are at present the first drugs line for patients with fluid retention and are necessary to relieve symptoms but cannot halt progression or improve the prognosis of CHF. Angiotensin-converting enzyme inhibitors (ACE inhibitors) therapy has been shown to decrease mortality and progression of CHF and should be used early in patients with left ventricular dysfunction whether they have symptomatic or asymptomatic CHF. Digoxin therapy is associated with decrease in the risk of worsening CHF irrespective of rhythm, systolic function, severity of CHF or therapy with ACE inhibitors. In patients with symptomatic CHF due to systolic dysfunction the addition of diuretics and digoxin appears to reducing worsening CHF without improving survival. Other than digoxin oral inotropic agents (amrinone, pimobendan, vesnarinone, ibopamine) increase mortality in patients with CHF and have not improved symptom status and other clinical endpoints during long-term therapy. Hydralazine and isosorbide dinitrate administrated in combination are less effective alternative to ACE inhibitors. Beta-blockers and particular carvedilol may prolong survival and decrease worsening CHF when used in combination with digoxine, diuretics and ACE inhibitors. Beta-blockers therapy improve hemodynamics, LVEF and functional status patients with CHF and the ideal candidate for this therapy is stable patients with NYHA II-III CHF due to nonischemic cause. Calcium antagonists do not appear to be useful in patients with CHF, although amlodipine and mibefradil appears to be safe for treatment of angina or hypertension in this group. On the basis of current data, antiarrhythmic agents should not be given to patients with CHF free from arrhythmia but those with sustained ventricular tachycardia or ventricular fibrillation amiodaron appears to be safe.